Provider Demographics
NPI:1174629356
Name:AUDIOLOGY ASSOCIATES PROFESSIONAL HEARING SERVICES OF NTH LA, INC.
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES PROFESSIONAL HEARING SERVICES OF NTH LA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:318-410-8000
Mailing Address - Street 1:805 STUBBS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5578
Mailing Address - Country:US
Mailing Address - Phone:318-410-8000
Mailing Address - Fax:318-410-8093
Practice Address - Street 1:805 STUBBS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5578
Practice Address - Country:US
Practice Address - Phone:318-410-8000
Practice Address - Fax:318-410-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3110332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136964Medicaid
LA1435376OtherDME
LA5CD25OtherGROUP
LA4C458CD25Medicare ID - Type Unspecified